Provider Demographics
NPI:1871633800
Name:CISNEROS, EDITH KATHLEEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:KATHLEEN
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MOHAWK ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1547
Mailing Address - Country:US
Mailing Address - Phone:661-444-3384
Mailing Address - Fax:661-631-2551
Practice Address - Street 1:841 MOHAWK ST
Practice Address - Street 2:SUITE 250
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1547
Practice Address - Country:US
Practice Address - Phone:661-444-3384
Practice Address - Fax:661-631-2551
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist